Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | CP001726 |
NPI | 1326197559 |
---|---|
Provider Name | Karen Christine Reiff |
First Address | Republic, MO 65738-1770 |
Second Address | Springfield, MO 65807-7303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
186285 | BCBS OF MO PROVIDER ID (01) |